Mid-term Results of Femoral and Tibial Osteotomies and Fassier-Duval Nailing in Children With Osteogenesis Imperfecta

Azzam, Khalid; Rush, Eric T.; Burke, Bridget R.; Nabower, Aleisha M.; Esposito, Paul W.

doi:10.1097/bpo.0000000000000824

Cited by 61 publications

(74 citation statements)

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“…Femora and tibiae are usually rodded bilaterally in moderate and severe forms but unilaterally in mild forms. In agreement with Azzam et al and Ruck et al 7 , 14 , we found that expanding intramedullary rods were used more often in femora and non-expanding rods were used more often in tibiae. Although this study could not compare the results of surgical procedures over different time periods, it did show that the practice of rodding has shifted toward simultaneous rodding of multiple bones in Type-III and IV subjects and to earlier surgical procedures in Type-III subjects, most likely because of improvements in surgical instrumentation and techniques.…”

Section: Discussionsupporting

confidence: 93%

“…A limitation of this study was that mobility outcomes before and after the surgical procedures, where benefits in both OI types III and IV have been reported 7 , 14 , 34 , were not compared, and the data were analyzed at variable times after the surgical procedure. Also, fracture information was available for only about half of the population, with data collected in a variable number of visits, and, even though multidisciplinary treatment, which is associated with the best results 34 , 41 , 45 , was offered in all centers, the contributions of the different interventions and their interactions were not evaluated.…”

Section: Discussionmentioning

confidence: 99%

“…The current genetic classification has extended to at least 16 subtypes 6 . A commonly accepted nomenclature does not yet exist 7 . However, decisions regarding surgical procedures and other medical decisions are usually made on the basis of the clinical severity of the disease using a modified Sillence classification identifying mild disease (Type I), moderate disease (Type IV), and severe disease (Type III) 8 .…”

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confidence: 99%

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A Multicenter Study of Intramedullary Rodding in Osteogenesis Imperfecta

et al. 2020

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Background: Osteogenesis imperfecta (OI), a heritable connective tissue disorder with wide clinical variability, predisposes to recurrent fractures and bone deformity. Management requires a multidisciplinary approach in which intramedullary rodding plays an important role, especially for moderate and severe forms. We investigated the patterns of surgical procedures in OI in order to establish the benefits of rodding. The main hypothesis that guided this study was that rodded participants with moderate and severe OI would have lower fracture rates and better mobility. Methods: With data from the Linked Clinical Research Centers, we analyzed rodding status in 558 individuals. Mobility and fracture data in OI Types III and IV were compared between rodded and non-rodded groups. Univariate regression analyses were used to test the association of mobility outcomes with various covariates pertinent to rodding. Results: Of the individuals with OI, 42.1% had undergone rodding (10.7% of those with Type I, 66.4% with Type III, and 67.3% with Type IV). Rodding was performed more frequently and at a younger age in femora compared with tibiae. Expanding intramedullary rods were used more frequently in femora. In Type III, the rate of fractures per year was significantly lower (p ≤ 0.05) for rodded bones. In Type III, the mean scores on the Gillette Functional Assessment Questionnaire (GFAQ) and Brief Assessment of Motor Function (BAMF) were higher in the rodded group. However, Type-IV non-rodded subjects had higher mean scores in nearly all mobility outcomes. OI type, the use of expanding rods in tibiae, and anthropometric measurements were associated with mobility outcomes scores. Conclusions: Current practice in 5 orthopaedic centers with extensive experience treating OI demonstrates that most individuals with moderate and severe types of OI undergo rodding procedures. Individuals with severe OI have improved mobility outcomes and lower fracture rates compared with their non-rodded peers, which suggests that early bilateral rodding benefits OI Type III. Our analysis showed a change in practice patterns in the final years of the study in the severe forms, with earlier and more simultaneous rodding procedures performed. Level of Evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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A Multicenter Study of Intramedullary Rodding in Osteogenesis Imperfecta

et al. 2020

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“…The main limitation with both components (sleeve and obturator) of telescopic rods is the presence of a narrow medullary canal, as the TIR also requires a minimum diameter for the medullary canal (3.2 mm) for both components to be used as a telescopic system. 31 …”

Section: Discussionmentioning

confidence: 99%

Effects of a telescopic intramedullary rod for treating patients with osteogenesis imperfecta of the femur

Rosemberg

Goiano

Akkari

et al. 2018

Journal of Children's Orthopaedics

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PurposeTo introduce a new model of telescopic intramedullary rod (TIR), evaluate its effects on treating patients presenting with moderate and severe osteogenesis imperfecta (OI) and to compare the findings with those of other telescopic rods.MethodsA total of 21 patients (nine girls and 12 boys; mean age at first operation, 6.6 years, 1.52 to 13.18) who underwent 52 femoral operations were monitored during a mean of 9.96 years (3.39 to 14.54). Patient characteristics, telescoping rod capability and its complications were examined.ResultsAccording to the Sillence classification, we investigated one patient with type I, nine with type III and 11 with type IV OI. Revision rates at up to five years (36%) were inferior to those found for the Fassier-Duval rod (46%). The main cause of revision was fracture (15 patients), followed by rod migration (nine), and infection (two). The rod exhibited higher telescopic capacity in boys than girls. Type III most commonly required an operation; the age group with the highest number of procedures was five to ten years. Male migration was the main cause of rod migration.ConclusionThe TIR has a satisfactory cost-benefit ratio with less complication rates and low production costs. The TIR is a feasible alternative to the commonly used Fassier-Duval rod.Level of EvidenceIV

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“…Common reasons for femoral FD nail revision included femoral fracture, bending of the rod, and proximal rod migration. [ 6 , 7 ]…”

Section: Discussionmentioning

confidence: 99%

Corrective osteotomy with retrograde Fassier-Duval nail in an osteogenesis imperfecta patient with bilateral genu valgum

Lin

Yang²,

Liu³

2017

Medicine

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Rationale:The treatment of osteogenesis imperfecta (OI) requires a multidisciplinary approach to maximize function and reduce fracture incidence. The aim of this case report was to discuss an alternative surgical approach to stabilize a corrective osteotomy using the Fassier Duval (FD) system in an OI patient.Patient concerns:A 20-year-old OI woman presented with left thigh pain, gait disturbance, and bilateral genu valgus deformities.Diagnoses:Physical examination and standing radiographs revealed bilateral genu valgum with previous fixation implants in the femoral and the left tibia.Interventions:Staged surgery was performed. A previous Ender pin was removed from the left femur, and a FD nail was inserted in a retrograde fashion. An intercondylar fracture was encountered while inserting the female rod in the distal left femur. After removal of a previous Rush pin from the right femur, several complications were also encountered during FD nailing of the right femur. The tip threads of the FD male nail could not achieve adequate anchorage in the region of the greater trochanter. To prevent male nail dropping, a horizontal stop Kirschner pin was inserted close to the distal end of the female nail.Outcome:Despite perioperative problems such as rod dropping and occurrence of an intercondylar fracture of the left distal femur, bilateral retrograde nailing using the FD system was successful. An accurate entry portal is important when performing retrograde rodding. In addition, reaming the portal to a larger diameter in order to accommodate the large head of the female nail can prevent intraoperative intercondylar split, especially when combined with an osteotomy at the distal femur.Lessons:Selection of the proper surgical technique is dependent on both the surgeon's experience and the condition of the patient. Although not an optimal device, a FD nail can be used as an IM nail for corrective osteotomy at the distal femur in an adult OI patient with a small femoral IM canal.

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Mid-term Results of Femoral and Tibial Osteotomies and Fassier-Duval Nailing in Children With Osteogenesis Imperfecta

Abstract: Therapeutic study to investigate the results of treatment with FD rods. Retrospective case series model of Level IV evidence quality.

Cited by 61 publications

References 28 publications

A Multicenter Study of Intramedullary Rodding in Osteogenesis Imperfecta

A Multicenter Study of Intramedullary Rodding in Osteogenesis Imperfecta

Effects of a telescopic intramedullary rod for treating patients with osteogenesis imperfecta of the femur

Corrective osteotomy with retrograde Fassier-Duval nail in an osteogenesis imperfecta patient with bilateral genu valgum

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